Provider Demographics
NPI:1104569664
Name:ALYEA, MADELYNN
Entity type:Individual
Prefix:
First Name:MADELYNN
Middle Name:
Last Name:ALYEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7763
Mailing Address - Country:US
Mailing Address - Phone:828-449-4418
Mailing Address - Fax:
Practice Address - Street 1:885 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7763
Practice Address - Country:US
Practice Address - Phone:828-449-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer